Choppers down

THE recent rise in accidents and fatalities from crashes of medical aircraft calls for a closer look at their increasing use in medical care.

Obviously, in cases where patient survival is limited to a small window of time, medical helicopters, which can get to hospitals more quickly than ground transportation, are lifesavers.

But the recent collision between two medical choppers in Flagstaff, Ariz., has renewed questions about not only their safety but the necessity of using them to transport other than the most critical of patients. With the air ambulance business booming, it is prudent to ask what the cost of such growth is in terms of both patient safety and medical expense.

The two helicopters that collided and killed six people on the way to Flagstaff Medical Center represent the ninth accident this year involving medical emergency aircraft. According to the National Transportation Safety Board, that brings the number of deaths from medical chopper crashes to 16.

The NTSB, which calls the problem a serious one, notes that crashes of medical aircraft have been on the rise since the 1990s. Part of the reason is there are simply more of them - roughly 400 in 2002 to more than 800 now - combined with other factors like emergency rooms closing in rural areas and an aging population.

A report by the Congressional Research Service found that from 2002 to 2005 one of every 50 medical helicopters in the U.S. fleet was involved in a crash. That's a far deadlier rate than that of the U.S. airline industry, which earlier this decade went almost five years without a single commercial jetliner crash.

Experts who have researched accident rates of medical helicopters suggest the flights benefit only a small subset of patients. Dr. Bryan Bledsoe, an emergency medicine physician who teaches at the University of Nevada and has studied EMS helicopter operations, says two out of three patients transported by a helicopter generally have minor injuries, and one in four is sent home without being admitted to the hospital.

Plus, there's the cost. Analysts point out that emergency transport companies can charge insurance companies virtually whatever they want because they're often dealing with severe injuries. But the air ambulance industry argues it provides a valuable service not only to victims in grave condition but to patients in remote locations, whose care may be delayed by ground transportation.

The question persists: Are medical helicopters being used too often in cases in which an ordinary ground ambulance would be just as good and maybe safer? An examination of the standards set for summoning emergency helicopters might be a good place to start looking for answers.

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